title: Follow-up routines in gynecological cancer - time for a change?
abstract: OBJECTIVE
  To determine current practice of follow-up of Norwegian gynecological cancer patients, and to review available randomized controlled trials (RCTs) in gynecologic, breast and colorectal cancer patients in order to discuss whether such studies are feasible in gynecological cancer patients.
  
  
  METHODS
  A combined questionnaire study and a systematic review of RCTs in follow-up of gynecological, breast, and colorectal cancers.
  
  
  METHODS
  Gynecological, breast, and colorectal cancer patients.
  
  
  METHODS
  A questionnaire regarding follow-up routines was mailed to 31 gynecological departments in Norway. A systematic search on MEDLINE, EMBASE, and the Cochrane Library databases was conducted to identify RCTs in follow-up of breast, colorectal, and gynecological cancers.
  
  
  RESULTS
  The questionnaire study showed that the number of controls varied from eight to 16 during the first five years' post-treatment. Routine investigations such as chest X-ray and cytology were frequently used in endometrial and cervical cancer. All departments used CA-125 in follow-up of ovarian cancer patients. Reviewing the literature, 19 RCTs of varying methodological quality were identified for colorectal and breast cancers, and none for gynecologic cancer. Different follow-up models were compared, and most studies concluded that there were no significant differences in the detection of recurrence, overall survival, and quality of life between the studied groups.
  
  
  CONCLUSIONS
  Follow-up routines after gynecological cancer vary in Norway. The optimal approach is unknown and RCTs comparing follow-up protocols are missing. Studies of breast and colorectal cancer patients show that studies on follow-up strategies are feasible but sufficient sample size and observation time are important.
authors.affiliation: Department of Obstetrics and Gynecology, Sorlandet Hospital HF, Kristiansand, Norway. ingvild.vistad@sshf.no
authors.forename: Ingvild
authors.initials: I
authors.lastname: Vistad
authors.forename: Birgit W
authors.initials: BW
authors.lastname: Moy
authors.forename: Helga B
authors.initials: HB
authors.lastname: Salvesen
authors.forename: Astrid H
authors.initials: AH
authors.lastname: Liavaag
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends; D003955:Diagnostic Tests, Routine; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D020380:Needs Assessment; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009664:Norway; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis